{"id":31199,"date":"2023-05-04T21:57:23","date_gmt":"2023-05-04T14:57:23","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31199"},"modified":"2023-05-04T21:57:23","modified_gmt":"2023-05-04T14:57:23","slug":"quy-trinh-noi-soi-dai-truc-trang-ong-mem-cua-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/quy-trinh-noi-soi-dai-truc-trang-ong-mem-cua-bo-y-te\/","title":{"rendered":"Quy tr\u00ecnh n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u1ed1ng m\u1ec1m c\u1ee7a B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt \u0111\u01b0a m\u1ed9t \u1ed1ng soi m\u1ec1m qua h\u1eadu m\u00f4n \u0111i ng\u01b0\u1ee3c l\u00ean \u0111\u1ebfn manh tr\u00e0ng \u0111\u1ec3 quan s\u00e1t to\u00e0n b\u1ed9 ni\u00eam m\u1ea1c \u0111\u1ea1i tr\u00e0ng. N\u1ebfu c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh sinh thi\u1ebft t\u1ed5n th\u01b0\u01a1ng \u1edf \u0111\u1ea1i tr\u00e0ng v\u00e0 m\u1ed9t s\u1ed1 th\u1ee7 thu\u1eadt nh\u01b0 c\u1eaft polyp, l\u1ea5y d\u1ecb v\u1eadt, ti\u00eam c\u1ea7m m\u00e1u.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u1ed1ng m\u1ec1m<\/span><\/b><\/h2>\n

1.1. N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng ch\u1ea9n \u0111o\u00e1n<\/span><\/b><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb m\u1eafc ung th\u01b0 \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

– \u0110i ngo\u00e0i ph\u00e2n \u0111en (soi d\u1ea1 d\u00e0y b\u00ecnh th\u01b0\u1eddng)<\/span><\/p>\n

– Thi\u1ebfu m\u00e1u<\/a> ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Test t\u00ecm h\u1ed3ng c\u1ea7u trong ph\u00e2n d\u01b0\u01a1ng t\u00ednh<\/span><\/p>\n

– Ti\u00eau ch\u1ea3y k\u00e9o d\u00e0i<\/a> ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Ti\u00eau ch\u1ea3y c\u1ea5p t\u00ednh<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n ph\u00e2n<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n \u0111\u1ea1i ti\u1ec7n<\/span><\/p>\n

– Ki\u1ec3m tra nh\u1eefng b\u1ea5t th\u01b0\u1eddng tr\u00ean phim XQ khung \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

– \u0110au b\u1ee5ng kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a th\u1ea5p kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Soi ki\u1ec3m tra \u0111\u1ecbnh k ng\u01b0\u1eddi b\u1ec7nh c\u00f3 polyp, ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/span><\/p>\n

– B\u1ec7nh t\u00fai th\u1eeba<\/span><\/p>\n

– C\u00e1c b\u1ec7nh vi\u00eam \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

1.2. N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

– C\u1eaft polyp<\/span><\/p>\n

– L\u1ea5y d\u1ecb v\u1eadt<\/span><\/p>\n

– C\u1ea7m m\u00e1u<\/span><\/p>\n

– Nong ch\u1ed7 h\u1eb9p<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb xo\u1eafn \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

1.3. N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng theo d\u00f5i<\/span><\/b><\/h3>\n

– Sau c\u1eaft polyp<\/span><\/p>\n

– C\u00f3 lo\u1ea1n s\u1ea3n n\u1eb7ng<\/span><\/p>\n

2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u1ed1ng m\u1ec1m<\/span><\/b><\/h2>\n

Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng Vi\u00eam ph\u00fac m\u1ea1c Suy tim<\/span><\/p>\n

Ng\u01b0\u1eddi b\u1ec7nh nh\u1ed3i m\u00e1u c\u01a1 tim m\u1edbi<\/span><\/p>\n

M\u1edbi ph\u1eabu thu\u1eadt \u1edf \u0111\u1ea1i tr\u00e0ng, m\u1ed5 \u1edf ti\u1ec3u khung<\/span><\/p>\n

Ph\u00ecnh l\u1edbn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng<\/span><\/p>\n

B\u1ec7nh t\u00fai th\u1eeba c\u1ea5p t\u00ednh<\/span><\/p>\n

Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 t\u1eafc m\u1ea1ch ph\u1ed5i<\/span><\/p>\n

T\u00ecnh tr\u1ea1ng shock<\/span><\/p>\n

Ng\u01b0\u1eddi b\u1ec7nh \u0111ang c\u00f3 thai (3 th\u00e1ng \u0111\u1ea7u v\u00e0 3 th\u00e1ng cu\u1ed1i)<\/span><\/p>\n

3. Chu\u1ea9n b\u1ecb<\/span><\/b><\/h2>\n

3.1. Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n<\/span><\/h3>\n

– 1 B\u00e1c s\u0129 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o v\u1ec1 n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea5p ch\u1ee9ng ch\u1ec9 n\u1ed9i soi<\/span><\/p>\n

– 2 \u0111i\u1ec1u d\u01b0\u1ee1ng<\/span><\/p>\n

3.2. Ph\u01b0\u01a1ng ti\u1ec7n<\/span><\/h3>\n

– 1 m\u00e1y n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng \u1ed1ng m\u1ec1m c\u00f3 video ho\u1eb7c kh\u00f4ng c\u00f3 video, c\u00f3 chi\u1ec1u d\u00e0i 130-140cm ho\u1eb7c 165-180cm<\/span><\/p>\n

– 1 k\u00ecm sinh thi\u1ebft ph\u00f9 h\u1ee3p v\u1edbi k\u00eanh sinh thi\u1ebft c\u1ee7a m\u00e1y<\/span><\/p>\n

– Overtube<\/span><\/p>\n

– Thu\u1ed1c nhu\u1ed9m m\u00e0u \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd: xanhmethylene, Indigocarmin,<\/span><\/p>\n

– Thu\u1ed1c ti\u1ec1n m\u00ea: Seduxen 10mg, Hypnovel 2.5-5mg<\/span><\/p>\n

3.3. Ng\u01b0\u1eddi b\u1ec7nh<\/span><\/h3>\n

– Ch\u1ebf \u0111\u1ed9 \u0103n<\/span><\/p>\n

Ng\u1eebng c\u00e1c thu\u1ed1c c\u00f3 ch\u1ee9a s\u1eaft 3-4g ng\u00e0y tr\u01b0\u1edbc soi<\/span><\/p>\n

\u0102n ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng c\u00f3 ch\u1ea5t x\u01a1 1 ng\u00e0y tr\u01b0\u1edbc soi<\/span><\/p>\n

– L\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng b\u1eb1ng 2 c\u00e1ch<\/span><\/p>\n

+ D\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng: C\u00f3 nhi\u1ec1u lo\u1ea1i thu\u1ed1c nh\u01b0ng hi\u1ec7n nay d\u00f9ng Fortrans, Fleet. D\u00f9ng 3 g\u00f3i thu\u1ed1c pha v\u00e0o 3 l\u00edt n\u01b0\u1edbc \u0111un s\u00f4i \u0111\u1ec3 ngu\u1ed9i u\u1ed1ng tr\u01b0\u1edbc khi soi 6 gi\u1edd<\/span><\/p>\n

Ch\u00fa \u00fd: N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u00e1n t\u1eafc hay t\u1eafc ru\u1ed9t kh\u00f4ng d\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng<\/span><\/p>\n

+ Ph\u01b0\u01a1ng ph\u00e1p th\u1ee5t r\u1eeda: N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c thu\u1ed1c nhu\u1eadn tr\u00e0ng ho\u1eb7c ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u00e1n t\u1eafc ru\u1ed9t, th\u1ee5t s\u1ea1ch 3 l\u1ea7n tr\u01b0\u1edbc khi soi<\/span><\/p>\n

Ch\u00fa \u00fd: \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh b\u1ecb t\u00e1o b\u00f3n c\u1ea7n d\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng 3 ng\u00e0y tr\u01b0\u1edbc khi soi: Forlax, Duphalac theo li\u1ec1u khuy\u1ebfn c\u00e1o<\/span><\/p>\n

– H\u1ecfi k\u1ef9 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c ti\u1ec1n m\u00ea, gi\u1ea3m \u0111au, gi\u1ea3m nhu \u0111\u1ed9ng<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh k\u00fd v\u00e0o gi\u1ea5y \u0111\u1ed3ng \u00fd soi<\/span><\/p>\n

3.4. H\u1ed3 s\u01a1 b\u1ec7nh \u00e1n<\/span><\/h3>\n

4. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u1ed1ng m\u1ec1m<\/span><\/b><\/h2>\n

– Ki\u1ec3m tra h\u1ed3 s\u01a1<\/span><\/p>\n

– Ki\u1ec3m tra ng\u01b0\u1eddi b\u1ec7nh<\/span><\/p>\n

– Th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt<\/span><\/p>\n

4.1. Nguy\u00ean t\u1eafc chung<\/span><\/h3>\n

B\u01a1m h\u01a1i v\u1eeba \u0111\u1ee7 v\u00e0 h\u00fat h\u01a1i th\u1eeba \u0111\u1ec3 tr\u00e1nh ch\u01b0\u1edbng h\u01a1i<\/span><\/p>\n

\u0110\u01b0a \u0111\u00e8n v\u00e0o nh\u1eb9 nh\u00e0ng v\u00e0 ch\u1ec9 \u0111\u01b0a m\u00e1y khi \u0111\u00e3 nh\u00ecn r\u00f5 \u0111\u01b0\u1eddng<\/span><\/p>\n

Ph\u1ea3i r\u00fat b\u1edbt m\u00e1y v\u00e0 l\u00e0m ng\u1eafn l\u1ea1i m\u1ed7i khi c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c<\/span><\/p>\n

Khi kh\u00f3 \u0111\u01b0a m\u00e1y ph\u1ea3i thay \u0111\u1ed5i t\u01b0 th\u1ebf ng\u01b0\u1eddi b\u1ec7nh<\/span><\/p>\n

4.2. K\u1ef9 thu\u1eadt soi<\/span><\/h3>\n

T\u01b0 th\u1ebf ng\u01b0\u1eddi b\u1ec7nh: n\u1eb1m ng\u1eeda ho\u1eb7c nghi\u00eang tr\u00e1i<\/span><\/p>\n

– B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean: th\u0103m d\u00f2 h\u1eadu m\u00f4n, tr\u1ef1c tr\u00e0ng r\u1ed3i \u0111\u01b0a \u0111\u00e8n v\u00e0o sua khi \u0111\u00e3 b\u00f4i tr\u01a1n b\u1eb1ng lidocaine ho\u1eb7c silicone, KY<\/span><\/p>\n

– \u0110\u01b0a m\u00e1y qua tr\u1ef1c tr\u00e0ng: \u00edt g\u1eb7p kh\u00f3 kh\u0103n<\/span><\/p>\n

– \u0110\u01b0a m\u00e1y qua \u0111\u1ea1i tr\u00e0ng Sigma: c\u00f3 2 ki\u1ec3u cu\u1ed9n<\/span><\/p>\n

+ Cu\u1ed9n\u00a0<\/span>a<\/span>: khi \u0111\u1ea7y m\u00e1y, m\u00e1y ti\u1ebfn l\u00ean cao, ra ph\u00e1i tr\u01b0\u1edbc tr\u1ef1c tr\u00e0ng, sau \u0111\u00f3 l\u1ea1i v\u00f2ng xu\u1ed1ng v\u00e0 ra sau. Ph\u1ea3i h\u00fat h\u01a1i v\u00e0 quay \u0111\u00e8n theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i v\u00e0 h\u00fat h\u01a1i<\/span><\/p>\n

+ Cu\u1ed9n ki\u1ec3u\u00a0<\/span>g<\/span>: thay \u0111\u1ed5i t\u01b0 th\u1ebf h\u00fat h\u01a1i v\u00e0 \u00e9p v\u00e0o v\u00f9ng h\u1ed1 ch\u1eadu tr\u00e1i, b\u00ecnh th\u01b0\u1eddng g\u00f3c tr\u00e1i c\u00e1ch h\u1eadu m\u00f4n 40-70cm<\/span><\/p>\n

– \u0110\u01b0a m\u00e1y qua g\u00f3c l\u00e1ch: – ni\u00eam m\u1ea1c \u0111\u1ea1i tr\u00e0ng v\u00f9ng g\u00f3c l\u00e1ch nh\u1eadn bi\u1ebft d\u1ec5 qua n\u1ed9i soi, khi kh\u00f3 \u0111\u1ea9y \u0111\u1ebbn ph\u1ea3i r\u00fat \u0111\u00e8n quay ng\u01b0\u1ee3c kim \u0111\u1ed3ng h\u1ed3 ho\u1eb7c thay \u0111\u1ed5i t\u01b0 th\u1ebf<\/span><\/p>\n

– Qua \u0111\u1ea1i tr\u00e0ng ngang: khi \u0111o\u1ea1n n\u00e0y qu\u00e1 d\u00e0i ph\u1ea3i h\u00fat b\u1edbt h\u01a1i v\u00e0 \u00e9p b\u1ee5ng \u1edf v\u00f9ng \u0111\u1ea1i tr\u00e0ng Sigma<\/span><\/p>\n

– T\u1edbi manh tr\u00e0ng: h\u00fat b\u1edbt h\u01a1i v\u00e0 \u00e9p v\u00e0o v\u00f9ng \u0111\u1ea1i tr\u00e0ng ngang ho\u1eb7c \u0111\u1ea1i tr\u00e0ng Sigma, \u0111\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch v\u00e0 gi\u1eefa b\u1ee5ng<\/span><\/p>\n

– Qua van Bauhin: h\u01b0\u1edbng \u0111\u1ea7u \u0111\u00e8n xu\u1ed1ng s\u00e2u h\u01a1n v\u1ecb tr\u00ed c\u1ee7a van, sau \u0111\u00f3 b\u01a1m h\u01a1i c\u0103ng manh tr\u00e0ng, r\u1ed3i r\u00fat \u0111\u00e8n l\u00ean t\u1edbi m\u00e9p van. B\u01a1m h\u01a1i c\u0103ng \u0111\u1ec3 m\u1edf l\u1ed7 van v\u00e0 \u0111\u1ea9y \u0111\u00e8n v\u00e0o h\u1ed3i tr\u00e0ng \u0111\u1ec3 nh\u1eadn bi\u1ebft h\u1ed3i tr\u00e0ng<\/span><\/p>\n

5. Theo d\u00f5i<\/span><\/b><\/h2>\n

– Ng\u01b0\u1eddi b\u1ec7nh trong v\u00e0 sau khi qu\u00e1 tr\u00ecnh soi \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c tr\u00ean monitoring v\u1ec1 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng v\u00e0 \u0111\u1ed9 b\u00e3o h\u00f2a oxy<\/span><\/p>\n

– N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 d\u00f9ng thu\u1ed1c ti\u1ec1n m\u00ea theo d\u00f5i cho t\u1edbi l\u00fac t\u1ec9nh ho\u00e0n to\u00e0n<\/span><\/p>\n

– Theo d\u00f5i m\u1ea1ch huy\u1ebft \u00e1p v\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0: \u0111au b\u1ee5ng, ch\u01b0\u1edbng b\u1ee5ng, bu\u1ed3n n\u00f4n,<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 l\u00e0m th\u1ee7 thu\u1eadt c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng b\u00e1o \u0111\u1ed9ng: \u0111au b\u1ee5ng, \u1ec9a ra m\u00e1u<\/span><\/p>\n

6. Tai bi\u1ebfn v\u00e0 x\u1eed tr\u00ed<\/span><\/b><\/h2>\n

6.1. Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng<\/span><\/b>: <\/span><\/h3>\n

Hay g\u1eb7p nh\u1ea5t (0.14%-0.2%)<\/span><\/p>\n

– V\u1ecb tr\u00ed hay th\u1ee7ng: \u0111\u1ea1i tr\u00e0ng Sigma<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa l\u00e0 ch\u00ednh<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea1i tr\u00e0ng chu\u1ea9n b\u1ecb r\u1ea5t s\u1ea1ch: h\u00fat s\u1ea1ch d\u1ecbch, kh\u00e1ng\u00a0sinh, nu\u00f4i d\u01b0\u1ee1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Theo d\u00f5i s\u00e1t \u0111\u1ec3 ph\u1eabu thu\u1eadt k\u1ecbp th\u1eddi.<\/span><\/p>\n

6.2. Nhi\u1ec5m khu\u1ea9n huy\u1ebft: <\/span><\/b><\/h3>\n

Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 cao: ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i thay van nh\u00e2n t\u1ea1o, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch, x\u01a1 gan c\u1ed5 tr\u01b0\u1edbng.<\/span><\/p>\n

6.3. Tr\u01b0\u1edbng h\u01a1i nhi\u1ec1u<\/span><\/b>: <\/span><\/h3>\n

h\u00fat h\u1ebft h\u01a1i<\/span><\/p>\n

6.4. Ph\u1ea3n x\u1ea1 d\u00e2y X<\/span><\/b>: <\/span><\/h3>\n

D\u00f9ng Atropin<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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